Effects of Interpleural Bupivacaine on Respiratory Muscle Strength and Pulmonary Function

1995 ◽  
Vol 83 (1) ◽  
pp. 48-55. ◽  
Author(s):  
Lluis Gallart ◽  
Joaquim Gea ◽  
M. Carmen Aguar ◽  
Joan M. Broquetas ◽  
Margarita M. Puig
Keyword(s):  
Heart Rate ◽  
Muscle Strength ◽  
Lung Function ◽  
Respiratory Function ◽  
Breathing Pattern ◽  
Respiratory Muscles ◽  
Lung Volumes ◽  
Time Index ◽  
Tension Time ◽  
Airway Conductance

Background Several reports suggest that interpleural local anesthetics may have deleterious effects on respiratory function. The current study investigated the effects of interpleural bupivacaine on human respiratory muscles and lung function. Methods Thirteen patients (55 +/- 4 yr old) with normal respiratory function and scheduled for cholecystectomy entered the study before surgery. Respiratory parameters were compared before and after the interpleural administration of 20 ml 0.5% bupivacaine plus 1:200,000 epinephrine while patients were supine; we evaluated breathing pattern, dynamic and static lung volumes, airway conductance, maximal inspiratory pressures (at the mouth; at the esophagus [Pessniff]; at the abdomen [Pgasniff]; and transdiaphragmatic [Pdisniff]), functional reserve (tension-time index) of the diaphragm, and maximal expiratory pressures (at the mouth; at the esophagus [Pescough]; and at the abdomen [Pgacough]). Hemoglobin oxygen saturation by pulse oximetry, heart rate, and mean arterial pressure were continuously monitored. Results Respiratory rate (15 +/- 1 to 19 +/- 1 breaths/min; P < 0.01) and heart rate (78 +/- 3 to 83 +/- 3 beats/min; P < 0.01) were slightly increased. Dynamic and static lung volumes, airway conductance, hemoglobin saturation, and the remaining breathing pattern parameters were unchanged. Regarding respiratory muscles, maximal inspiratory pressure at the mouth, Pessniff, and tension-time index of the diaphragm did not change. Pdisniff decreased slightly (102 +/- 10 to 92 +/- 10 cmH2O; P < 0.05) because of a change in Pgasniff (24.2 +/- 7.4 to 18.4 +/- 6.8 cmH2O; P < 0.05). Maximal expiratory pressure at the mouth remained unaltered, but Pgacough decreased (108 +/- 10 to 92 +/- 8 cmH2O; P < 0.01), and Pescough showed a trend to decrease (92 +/- 13 to 78 +/- 10 cmH2O; P = 0.074). Conclusions In our experimental conditions, interpleural bupivacaine did not significantly change lung function or inspiratory muscle strength but induced a slight decrease in abdominal muscle strength. Although this effect was minimal, its clinical relevance needs to be evaluated further in patients with impaired respiratory function.

Physiological Determinants of Inspiratory Effort Sensation during CO2 Rebreathing in Normal Subjects

1993 ◽  
Vol 85 (5) ◽  
pp. 637-642 ◽  
Author(s):  
J. E. Clague ◽  
J. Carter ◽  
M. G. Pearson ◽  
P. M. A. Calverley
Keyword(s):  
Partial Pressure ◽  
Muscle Fatigue ◽  
Breathing Pattern ◽  
Normal Subjects ◽  
Inspiratory Effort ◽  
Inspiratory Muscle ◽  
Time Index ◽  
Partial Pressure Of Co2 ◽  
Tension Time ◽  
Inspiratory Muscle Fatigue

1. The physiological basis of inspiratory effort sensation remains uncertain. Previous studies have suggested that pleural pressure, rather than inspiratory muscle fatigue, is the principal determinant of inspiratory effort sensation. However, only a limited range of inspiratory flows and breathing patterns have been examined. We suspected that inspiratory effort sensation was related to the inspiratory muscle tension-time index developed whatever the breathing pattern or load, and that this might explain the additional rise in sensation seen with hypercapnia. 2. To investigate this we measured hypercapnic re-breathing responses in seven normal subjects (six males, age range 21–38 years) with and without an inspiratory resistive load of 10 cm H2O. Pleural and transdiaphragmatic pressures, mouth occlusion pressure and breathing pattern were measured. Diaphragmatic and ribcage tension-time indices were calculated from these data. Inspiratory effort sensation was recorded using a Borg scale at 30s intervals during each rebreathing run. 3. Breathing pattern and inspiratory pressure partitioning were unrelated to changes in inspiratory effort sensation during hypercapnia. Tension-time indices reached pre-fatiguing levels during both free breathing and inspiratory resistive loading. 4. Stepwise multiple regression analysis using pooled mechanical, chemical and breathing pattern variables showed that pleural pressure was more closely related to inspiratory effort sensation than was transdiaphragmatic pressure. When converted to tension-time indices, ribcage tension-time index was the major determinant of inspiratory effort sensation during loaded rebreathing, but partial pressure of CO2 was an important independent variable, whereas during unloaded rebreathing partial pressure of CO2 was the most important determinant of inspiratory effort sensation. 5. These results suggest that the pattern of inspiratory pressure partitioning and inspiratory flow rate have little influence on inspiratory effort sensation during CO2 stimulated breathing. The close association between inspiratory effort sensation and ribcage tension-time index, an index of inspiratory muscle work, suggests that inspiratory effort sensation may forewarn of potential inspiratory muscle fatigue. Changes in PaCO2 have a small independent effect on respiratory perception.

scholarly journals Immediate Effects of Sforzesco® Bracing on Respiratory Function in Adolescents with Idiopathic Scoliosis

Healthcare ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1372
Author(s):  
Fabrizio Di Maria ◽  
Andrea Vescio ◽  
Alessia Caldaci ◽  
Ada Vancheri ◽  
Chiara Di Maria ◽  
...  
Keyword(s):  
Lung Function ◽  
Idiopathic Scoliosis ◽  
Lung Volume ◽  
Repeated Measures ◽  
Respiratory Function ◽  
Regression Equations ◽  
Lung Volumes ◽  
Perceived Effort ◽  
Predicted Values ◽  
The One

The thoraco-lumbar bracing is an effective management of adolescent idiopathic scoliosis (AIS). Studies have shown that brace wearing reduces lung volume. Whether or not the Sforzesco brace, frequently used in Italy, affects lung volume has not been investigated. We studied the immediate effect of Sforzesco bracing on lung volumes in 11 AIS patients (10 F, 1 M; aged 13.6 ± 1.6 yrs) mean Cobb angle 26 ± 4.49 degrees. Lung function variables and the perceived respiratory effort were recorded twice, before and 5 min after bracing. The one-way analysis of variance repeated measures, and multiple comparison tests, showed that means of unbraced variables were not significantly different from the corresponding means of predicted values, whereas means under brace were significantly lower (p < 0.05) compared to both predicted and baseline values of respiratory variables. In addition, a significant correlation (p < 0.0001) was found between unbraced and braced values, and linear regression equations were calculated. A significant but clinically unimportant increase in perceived effort was observed under the brace. In conclusion, data indicate that lung function is not impaired in moderate AIS and that wearing the Sforzesco brace causes an immediate, predictable reduction of lung volumes. Data also suggest that the respiratory discomfort during brace wearing could not be due to respiratory function defects.

Inspiratory muscle training reduces diaphragm activation and dyspnea during exercise in COPD

2018 ◽  
Vol 125 (2) ◽  
pp. 381-392 ◽  
Author(s):  
Daniel Langer ◽  
Casey Ciavaglia ◽  
Azmy Faisal ◽  
Katherine A. Webb ◽  
J. Alberto Neder ◽  
...  
Keyword(s):  
Muscle Strength ◽  
Respiratory Muscle ◽  
Breathing Pattern ◽  
Work Rate ◽  
Inspiratory Muscle ◽  
Inspiratory Muscle Training ◽  
Muscle Training ◽  
Lung Volumes ◽  
Exercise Endurance ◽  
Inspiratory Muscle Strength

Among patients with chronic obstructive pulmonary disease (COPD), those with the lowest maximal inspiratory pressures experience greater breathing discomfort (dyspnea) during exercise. In such individuals, inspiratory muscle training (IMT) may be associated with improvement of dyspnea, but the mechanisms for this are poorly understood. Therefore, we aimed to identify physiological mechanisms of improvement in dyspnea and exercise endurance following inspiratory muscle training (IMT) in patients with COPD and low maximal inspiratory pressure (Pimax). The effects of 8 wk of controlled IMT on respiratory muscle function, dyspnea, respiratory mechanics, and diaphragm electromyography (EMGdi) during constant work rate cycle exercise were evaluated in patients with activity-related dyspnea (baseline dyspnea index <9). Subjects were randomized to either IMT or a sham training control group ( n = 10 each). Twenty subjects (FEV1 = 47 ± 19% predicted; Pimax  = −59 ± 14 cmH2O; cycle ergometer peak work rate = 47 ± 21% predicted) completed the study; groups had comparable baseline lung function, respiratory muscle strength, activity-related dyspnea, and exercise capacity. IMT, compared with control, was associated with greater increases in inspiratory muscle strength and endurance, with attendant improvements in exertional dyspnea and exercise endurance time (all P < 0.05). After IMT, EMGdi expressed relative to its maximum (EMGdi/EMGdimax) decreased ( P < 0.05) with no significant change in ventilation, tidal inspiratory pressures, breathing pattern, or operating lung volumes during exercise. In conclusion, IMT improved inspiratory muscle strength and endurance in mechanically compromised patients with COPD and low Pimax. The attendant reduction in EMGdi/EMGdimax helped explain the decrease in perceived respiratory discomfort despite sustained high ventilation and intrinsic mechanical loading over a longer exercise duration. NEW & NOTEWORTHY In patients with COPD and low maximal inspiratory pressures, inspiratory muscle training (IMT) may be associated with improvement of dyspnea, but the mechanisms for this are poorly understood. This study showed that 8 wk of home-based, partially supervised IMT improved respiratory muscle strength and endurance, dyspnea, and exercise endurance. Dyspnea relief occurred in conjunction with a reduced activation of the diaphragm relative to maximum in the absence of significant changes in ventilation, breathing pattern, and operating lung volumes.

scholarly journals Physiotherapy improves symptoms of exercise-induced laryngeal obstruction in young elite athletes: a case series

2019 ◽  
Vol 5 (1) ◽  
pp. e000487 ◽  
Author(s):  
Liv-Jorunn Kolnes ◽  
Maria Vollsæter ◽  
Ola Drange Røksund ◽  
Trine Stensrud
Keyword(s):  
Lung Function ◽  
Respiratory Distress ◽  
Respiratory System ◽  
Breathing Pattern ◽  
Case Series ◽  
Respiratory Muscles ◽  
Provocation Test ◽  
Behavioural Therapy ◽  
Laryngeal Obstruction ◽  
Exercise Induced

ObjectiveA constricted, upper chest breathing pattern and postural dealignments habitually accompany exercise-induced laryngeal obstruction (EILO), but there are few effective treatments for athletes presenting with EILO. This case series was conducted to examine whether physiotherapy based on principles from the Norwegian psychomotor physiotherapy (NPMP) combined with elements of cognitive behavioural therapy can reduce laryngeal distress in athletes with EILO.MethodsRespiratory distress in four subjects was examined by interview prior to a physiotherapeutic body examination. Inappropriate laryngeal movements during exercise were measured by the continuous laryngoscopy exercise test, lung function was measured by flow-volume curves, and non-specific bronchial hyper-responsiveness was measured by a methacholine provocation test. History of asthma, allergy and respiratory symptoms was recorded in a modified AQUA2008questionnaire. Parasympathetic activity was assessed by pupillometry. All data were gathered before and after 5 months of intervention.ResultsPhysiotherapy based on the principles from NPMP improved breathing problems in athletes with EILO. All athletes had less respiratory distress, improved lung function at rest and reduced inappropriate laryngeal movements during maximal exercise.ConclusionA diaphragmatic breathing pattern, a more balanced tension in respiratory muscles, and sound cervical alignment and stability may help to reduce adverse stress on the respiratory system and optimise the function of the larynx during high-intensity exercise. Our results suggest that understanding and management of EILO need to extend beyond structures located in the anterior neck and include factors influencing the whole respiratory system.

A Review on Functions of Rakt Dhatu and Prana Vayu to Establish Lung Function Capacity

2018 ◽  
Vol 3 (01) ◽  
Author(s):  
Dr. Vishal Shamrao Patil ◽  
Dr. (Mrs.) Manisha V. Bhalsing
Keyword(s):  
Lung Function ◽  
Functional Status ◽  
Respiratory System ◽  
Lung Function Tests ◽  
Lung Volumes ◽  
Happy Life ◽  
Pathological Conditions ◽  
Function Tests ◽  
Forced Breathing

Lung function tests are useful in assessing the functional status of Respiratory system in both in physiological as well as pathological conditions. These are based on the measurement of volume of air breathed in and out in quite breathing & forced breathing. Air in lungs is classified in to two divisions’ lung volumes & lung capacities. Lung Capacities are the combination of two or more lung volumes. The concept of Rakt Dhatu & Vayu is important in case of respiration because Charaka says that pure blood provides the person with strength, luster & happy life because vital breath follows blood. It represents mechanism of oxygenated & deoxygenated blood & its relation with functioning capacity of Lungs. So In this article attempt has been made to review concepts regarding functions of Rakt Dhatu & Vayu to Establish Lung Function Capacity.

scholarly journals Simple low dose radiography allows precise lung volume assessment in mice

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Amara Khan ◽  
Andrea Markus ◽  
Thomas Rittmann ◽  
Jonas Albers ◽  
Frauke Alves ◽  
...  
Keyword(s):  
Lung Function ◽  
Whole Body ◽  
Acquisition Time ◽  
Micro Ct ◽  
Lung Volumes ◽  
X Ray ◽  
Promising Tool ◽  
Volume Assessment ◽  
Set Up ◽  
Time Required

AbstractX-ray based lung function (XLF) as a planar method uses dramatically less X-ray dose than computed tomography (CT) but so far lacked the ability to relate its parameters to pulmonary air volume. The purpose of this study was to calibrate the functional constituents of XLF that are biomedically decipherable and directly comparable to that of micro-CT and whole-body plethysmography (WBP). Here, we developed a unique set-up for simultaneous assessment of lung function and volume using XLF, micro-CT and WBP on healthy mice. Our results reveal a strong correlation of lung volumes obtained from radiographic XLF and micro-CT and demonstrate that XLF is superior to WBP in sensitivity and precision to assess lung volumes. Importantly, XLF measurement uses only a fraction of the radiation dose and acquisition time required for CT. Therefore, the redefined XLF approach is a promising tool for preclinical longitudinal studies with a substantial potential of clinical translation.

Peripheral muscle strength is associated with lung function and functional capacity in patients with cystic fibrosis

2019 ◽  
Vol 24 (3) ◽  
Author(s):  
Paula Maria Eidt Rovedder ◽  
Gabrielle Costa Borba ◽  
Mariluce Anderle ◽  
Josani Flores ◽  
Bruna Ziegler ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Muscle Strength ◽  
Lung Function ◽  
Functional Capacity ◽  
Peripheral Muscle

Heart Rate Variability And Respiratory Muscle Strength In Patients With Type Ii Diabetes Practicing Pilates: A Randomized Clinical Trial

2021 ◽  
Vol 17 ◽  
Author(s):  
Samara Sousa Vasconcelos Gouveia ◽  
Guilherme Pertinni de Morais Gouveia ◽  
Leydnaya Maria Souza ◽  
Bruno Cunha da Costa ◽  
Gustavo Henrique Melo Sousa ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Heart Rate ◽  
Heart Rate Variability ◽  
Muscle Strength ◽  
Normal Distribution ◽  
Randomized Clinical Trial ◽  
Respiratory Muscle ◽  
Control Group ◽  
Respiratory Muscle Strength

Purpose: This study aimed to analyze the effect of a Pilates protocol on respiratory muscle strength and heart rate variability (HRV) in patients with type 2 diabetes. Method: A randomized clinical trial (RBR-2gc2qj) was conducted with a type 2 diabetic target population. Patients practiced the Pilates protocol for 8 weeks, with two visits per week. The variables tested were maximum inspiratory pressure (MIP), maximum expiratory pressure (MEP), and HRV (time and frequency domains). All variables were tested for normal distribution. Using SPSS 21.0, analysis of variance was performed for variables with normal distribution, and the Wilcoxon and Friedman tests were used for variables that did not show a normal distribution, with a 5% significance level. Results: Forty-four participants were included in the study (intervention group: 22; control group: 22; mean age: 61.23 ± 8.49 years), most of whom were female (77.3%), married or in a consensual union (59.1%), had complete literacy (31.8%), and had an average body mass index of 26.96 ± 4.35 kg/m2. There were no significant differences in MIP and MEP before and after the protocol between the intervention and control groups. Regarding HRV, there were significant differences in autonomic modulation, especially between the moments before and during exercise and between the moments during and after exercise; however, it was not possible to determine which system (sympathetic or parasympathetic) is most involved in these changes. Conclusion: The exercise protocol based on the Pilates method did not alter respiratory muscle strength but promoted changes in HRV, especially between the moments before and during exercise and during and after exercise.

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